A randomised controlled trial to evaluate paediatric critical care telemedicine in Queensland

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In Queensland, facilities for seriously ill children are centralised in Brisbane. The Paediatric Intensive Care Unit (PICU) at the Royal Children's Hospital provides advice and retrieval services for children who have presented at rural and regional hospitals throughout Queensland. When advice is needed, it is provided by telephone and this relies on the ability of the remote clinician to provide a good verbal description of the patient and an accurate interpretation of paediatric x-rays. Clinicians at the remote hospital may be relatively inexperienced at caring for critically ill children. Support from the PICU is essential. Telemedicine allows clinicians to hold a consultation at a distance by video. In addition to face-to-face communication, telemedicine may be used to view the patient, the monitors and x-rays - as if present in the same room. The addition of visual information offers the potential for a much richer dialogue than is possible by telephone alone. Alongside high-quality local care and a well co-ordinated retrieval service, telemedicine may be a potentially useful tool. This is a new area of research and very little has been reported in the literature. A limited number of studies in the USA have shown that telemedicine assists in the management of seriously ill children at a distance. Over a three year period, this study will formally evaluate the use of telemedicine to provide critical care support from the RCH PICU to four regional hospital emergency departments. The study will provide evidence on the feasibility, clinical usefulness and economics of the approach within the Queensland context. The following hypotheses will be tested: Efficacy Paediatric critical care consultation by telemedicine will: (i) improve patient condition between initial call and retrieval team arrival; (ii) reduce the time needed by the retrieval team to stablise the patient before transport; (iii) reduce diagnostic discordance; (iv) reduce the number of retrieved patients admitted to general wards; (v) improve 30 day mortality. Economics Paediatric critical care telemedicine is economically beneficial from the health service perspective reducing the number and therefore cost of retrieval and unnecessary tertiary admission.